Polycythemia differential diagnosis: Difference between revisions

	Polycythemia Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Polycythemia from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Study of Choice
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
X-ray
Echocardiography or Ultrasound
CT scan
MRI
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Interventions
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Polycythemia differential diagnosis On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Polycythemia differential diagnosis All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Polycythemia differential diagnosis
CDC on Polycythemia differential diagnosis
Polycythemia differential diagnosis in the news
Blogs on Polycythemia differential diagnosis
Directions to Hospitals Treating Polycythemia
Risk calculators and risk factors for Polycythemia differential diagnosis

← Older edit Newer edit →

VisualWikitext

Revision as of 15:53, 21 August 2018

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sadaf Sharfaei M.D.[2]

Overview

Differential Diagnosis of Polycythemia

Polycythemia must be differentiated from a variety of other conditions.^[1]^[2]^[3]

Disease	Mutation		Etiology	Clinical manifestations										Laboratory findings						Treatment	Associated findings
	Mutation			Symptoms					Signs					CBC				Erythropoietin level	PBS
	JAK2 mutation	CALR mutation		Fatigue	Headache	Bleeding	Pain	Other symptoms	Appearance	Fever	Tenderness	Splenomegaly	Other signs	Hb	RBC	WBC	Plt	Erythropoietin level	PBS
Polycythemia vera (PV)	> 95%		Autonomous erythrocyte production		+	-	Erythromelagia	Stroke-like symptoms	Ruddy face	-	-	+	NA	↑	↑ RBC mass	Nl to ↑	Nl to ↑			Aspirin Ruxolitinib Hydroxyurea Phlebotomy Interferon-alpha	Stroke Venous thrombosis Myelofibrosis Acute leukemia






Secondary polycythemia due to hypoxemia	-	-	Chronic lung disease Right-to-left cardiac shunts Sleep apnea High altitude	+	+	-	Depends on etiology	Shortness of breath	Cyanosis			-	Crackles Tachypnea Tachycardia	↑	↑	Nl	Nl	↑		Treatment of underlying cause	Variable manifestations given the diverse etiologies
Secondary polycythemia due to erythropoietin producing tumor	-	-	Renal cell carcinoma Hepatocellular carcinoma Cerebellar hemangioblastoma Pheochromocytoma Uterine fibroids	+	-	-	Depends on etiology	Depends on etiology	Chronically ill	+/-	+/-	-	Hepatomegaly Bruising	↑/↓	↑/↓	Nl	↑	↑		Surgery Chemotherapy	Variable manifestations given the diverse etiologies
Disease	JAK2 mutation	CALR mutation	Etiology	Fatigue	Headache	Bleeding	Pain	Other symptoms	Appearance	Fever	Tenderness	Splenomegaly	Other signs	Hb	RBC	WBC	Plt	Erythropoietin level	PBS	Treatment	Associated findings

References

↑ Tefferi A, Barbui T (2015). "Polycythemia vera and essential thrombocythemia: 2015 update on diagnosis, risk-stratification and management". Am J Hematol. 90 (2): 162–73. doi:10.1002/ajh.23895. PMID 25611051.
↑ Sanchez S, Ewton A (2006). "Essential thrombocythemia: a review of diagnostic and pathologic features". Arch Pathol Lab Med. 130 (8): 1144–50. doi:10.1043/1543-2165(2006)130[1144:ET]2.0.CO;2. PMID 16879015.
↑ Jabbour E, Kantarjian H (2014). "Chronic myeloid leukemia: 2014 update on diagnosis, monitoring, and management". Am J Hematol. 89 (5): 547–56. doi:10.1002/ajh.23691. PMID 24729196.

[pmid25611051-1] Tefferi A, Barbui T (2015). "Polycythemia vera and essential thrombocythemia: 2015 update on diagnosis, risk-stratification and management". Am J Hematol. 90 (2): 162–73. doi:10.1002/ajh.23895. PMID 25611051.

[pmid16879015-2] Sanchez S, Ewton A (2006). "Essential thrombocythemia: a review of diagnostic and pathologic features". Arch Pathol Lab Med. 130 (8): 1144–50. doi:10.1043/1543-2165(2006)130[1144:ET]2.0.CO;2. PMID 16879015.

[pmid24729196-3] Jabbour E, Kantarjian H (2014). "Chronic myeloid leukemia: 2014 update on diagnosis, monitoring, and management". Am J Hematol. 89 (5): 547–56. doi:10.1002/ajh.23691. PMID 24729196.

[1]

[2]

[3]

@@ Line 9: / Line 9: @@
 {|
+!
 ! rowspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Disease
 ! colspan="2" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Mutation
@@ Line 17: / Line 18: @@
 ! rowspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Associated findings
 |-
+!
 ! colspan="5" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Symptoms
 ! colspan="5" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Signs
@@ Line 23: / Line 25: @@
 ! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |PBS
 |-
+!
 ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |JAK2 mutation
 ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |CALR mutation
@@ Line 40: / Line 43: @@
 ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Plt
 |-
-! align="center" style="background:#DCDCDC;" |[[Polycythemia vera (PV)]]
+!
+! align="center" style="background:#DCDCDC;" |Polycythemia vera (PV)
 | align="center" style="background:#F5F5F5;" |> 95%
 | align="center" style="background:#F5F5F5;" |
@@ Line 74: / Line 78: @@
 * [[Acute leukemia]]
 |-
-! align="center" style="background:#DCDCDC;" |[[Essential thrombocythemia]] (ET)
+!
-| align="center" style="background:#F5F5F5;" |50%
+!
-| align="center" style="background:#F5F5F5;" | +/-
+!
-| align="left" style="background:#F5F5F5;" |
+!
-* Clonal proliferation of megakaryocytes
+!
-* Excess [[platelet]] production
+!
-| align="center" style="background:#F5F5F5;" | +
+!
-| align="center" style="background:#F5F5F5;" |
+!
-| align="center" style="background:#F5F5F5;" | + (paradoxical)
+!
-| align="center" style="background:#F5F5F5;" |
+!
-| align="left" style="background:#F5F5F5;" |
+!
-* Stroke-like symptoms
+!
-| align="center" style="background:#F5F5F5;" |
+!
-| align="center" style="background:#F5F5F5;" |
+!
-| align="center" style="background:#F5F5F5;" |
+!
-| align="center" style="background:#F5F5F5;" | +
+!
-| align="center" style="background:#F5F5F5;" |[[Bruises]]
+!
-| align="center" style="background:#F5F5F5;" |
+!
-| align="center" style="background:#F5F5F5;" |
+!
-| align="center" style="background:#F5F5F5;" |
+!
-| align="center" style="background:#F5F5F5;" |↑ (dysfunctional platelets)
+!
-| align="center" style="background:#F5F5F5;" |
+!
-| align="center" style="background:#F5F5F5;" |
+!
-| align="left" style="background:#F5F5F5;" |
+|-
-* [[Aspirin]]
+!
-* [[Hydroyurea]]
+!
-* [[Anagrelide]]
+!
-| align="left" style="background:#F5F5F5;" |
+!
-* Acquired [[von Willebrand disease]]
+!
-* [[Myelofibrosis]]
+!
-* [[Acute leukemia]]
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+|-
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+|-
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
 |-
-! align="center" style="background:#DCDCDC;" |[[Chronic myeloid leukemia]] (CML)
+!
-| align="center" style="background:#F5F5F5;" | -
+!
-| align="center" style="background:#F5F5F5;" | -
+!
-| align="left" style="background:#F5F5F5;" |
+!
-* Reciprocal translocation of chromosomes 9 and 22
+!
-* Production of BCR-Abl kinase
+!
-| align="center" style="background:#F5F5F5;" | +
+!
-| align="center" style="background:#F5F5F5;" | +
+!
-| align="center" style="background:#F5F5F5;" | +
+!
-| align="center" style="background:#F5F5F5;" |[[Abdominal pain]]
+!
-| align="center" style="background:#F5F5F5;" |
+!
-| align="center" style="background:#F5F5F5;" |
+!
-| align="center" style="background:#F5F5F5;" | +
+!
-| align="center" style="background:#F5F5F5;" |
+!
-| align="center" style="background:#F5F5F5;" | +
+!
-| align="center" style="background:#F5F5F5;" |
+!
-| align="center" style="background:#F5F5F5;" |↑
+!
-| align="center" style="background:#F5F5F5;" |↑
+!
-| align="center" style="background:#F5F5F5;" |↑
+!
-| align="center" style="background:#F5F5F5;" |↑
+!
-| align="center" style="background:#F5F5F5;" |
+!
-| align="center" style="background:#F5F5F5;" |Elevated metamyelocytes and other [[white blood cells]] at various stages of maturation
+!
-| align="left" style="background:#F5F5F5;" |
+!
-* [[Imatinib]]
-* [[Dasatinib]]
-* [[Bosutinib]]
-* [[Nilotinib]]
-* [[Ponatinib]] for T315I kinase domain mutation
-* [[Interferon-alpha]]
-| align="left" style="background:#F5F5F5;" |
-* Can appear similar to [[leukemoid reaction]]
 |-
-! align="center" style="background:#DCDCDC;" |[[Primary myelofibrosis]] (PMF)
+!
-| align="center" style="background:#F5F5F5;" |
+!
-| align="center" style="background:#F5F5F5;" |
+!
-| align="left" style="background:#F5F5F5;" |
+!
-* Clonal disorder of [[megakaryocytes]]
+!
-* Excess production [[TGF-beta]] and [[collagen]]
+!
-| align="center" style="background:#F5F5F5;" | +
+!
-| align="center" style="background:#F5F5F5;" |
+!
-| align="center" style="background:#F5F5F5;" | +
+!
-| align="center" style="background:#F5F5F5;" |[[Abdominal pain]]
+!
-| align="left" style="background:#F5F5F5;" |
+!
-* Early satiety
+!
-| align="center" style="background:#F5F5F5;" |Pallor
+!
-| align="center" style="background:#F5F5F5;" |
+!
-| align="center" style="background:#F5F5F5;" |
+!
-| align="center" style="background:#F5F5F5;" | +
+!
-| align="left" style="background:#F5F5F5;" |
+!
-* [[Hepatomegaly]]
+!
-* [[Bruising]]
+!
-| align="center" style="background:#F5F5F5;" |↓
+!
-| align="center" style="background:#F5F5F5;" |↓
+!
-| align="center" style="background:#F5F5F5;" |↓
+!
-| align="center" style="background:#F5F5F5;" |↓
+!
-| align="center" style="background:#F5F5F5;" |
-| align="center" style="background:#F5F5F5;" |
-| align="left" style="background:#F5F5F5;" |
-* [[Hydroxyurea]]
-* [[Stem cell transplant]]
-* [[Ruxolitinib]]
-| align="left" style="background:#F5F5F5;" |
-* Variable risk for development of [[acute leukemia]]
 |-
-! align="center" style="background:#DCDCDC;" |Secondary polycythemia due to chronic hypoxia
+!
+! align="center" style="background:#DCDCDC;" |Secondary polycythemia due to hypoxemia
 | align="center" style="background:#F5F5F5;" | -
 | align="center" style="background:#F5F5F5;" | -
 | align="left" style="background:#F5F5F5;" |
-* [[Congestive heart failure]] (CHF)
+* Chronic lung disease
-* [[Interstitial lung disease]] (ILD)
+* [[Right-to-left shunt|Right-to-left cardiac shunts]]
-* [[Obstructive sleep apnea]] (OSA)
+* [[Sleep apnea]]
-* Smoking
+* [[Altitude sickness|High altitude]]
+*
 | align="center" style="background:#F5F5F5;" | +
 | align="center" style="background:#F5F5F5;" | +
@@ Line 203: / Line 257: @@
 * Variable manifestations given the diverse etiologies
 |-
+!
 ! align="center" style="background:#DCDCDC;" |Secondary polycythemia due to [[erythropoietin]] producing tumor
 | align="center" style="background:#F5F5F5;" | -
 | align="center" style="background:#F5F5F5;" | -
 | align="left" style="background:#F5F5F5;" |
-* Renal cell carcinoma
+*[[Renal cell carcinoma]]
-* Hepatocellular carcinoma
+*[[Hepatocellular carcinoma]]
+*Cerebellar [[hemangioblastoma]]
+*[[Pheochromocytoma]]
+*[[Leiomyoma|Uterine fibroids]]
 | align="center" style="background:#F5F5F5;" | +
 | align="center" style="background:#F5F5F5;" | -
@@ Line 233: / Line 291: @@
 * Variable manifestations given the diverse etiologies
 |-
+!
 ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Disease
 ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |JAK2 mutation

Polycythemia differential diagnosis: Difference between revisions

Revision as of 15:53, 21 August 2018

Overview

Differential Diagnosis of Polycythemia

References

Navigation menu

Search